The purpose of this program is to provide rigorous multidisciplinary research training for physician-scientists committed to careers in academic medicine and for PhD postdoctoral fellows in cardiovascular biology and medicine. Our training program incorporates two guiding principles: 1) biomedical research requires teams of investigators with diverse scientific and medical backgrounds possessing complementary expertise and perspective, and 2) there are no shortcuts to a career in cardiovascular research; rigorous didactic training, structured mentorship, a focused research project, and constructive feedback are required. The program is centered in the University of Pennsylvania Cardiovascular Institute (CVI), which includes 190 members in 16 departments performing a broad spectrum of cardiovascular science. Considerable infrastructure support from the School of Medicine is committed to the program, including integrated basic and translational research space and core laboratories in the Smilow Center for Translational Research. This renewal application will support 7 MD, MD/PhD, and PhD postdoctoral fellows per year performing 2-3 years of dedicated research training. Thirty-four NIH-funded Penn CVI faculty members in the Departments of Medicine, Surgery, Cell and Developmental Biology, Genetics, Physiology, Systems Pharmacology and Therapeutics, and Bioengineering, serve as trainers and mentors. Three tracks have been created. The Basic Track prepares trainees for careers in cardiovascular science using laboratory approaches. The Clinical and Translational Track prepares trainees for research careers at the interface of laboratory science and clinical investigation, including deep-phenotyping in human subjects, applied genomics, novel devices, and therapeutics. A new track in Outcomes and Health Services Research prepares trainees for careers that leverage big data to improve health care delivery and outcomes. The core of our curriculum is a supervised research preceptorship. Practical research training is supplemented by graduate and medical school classwork, lectures, seminars, skill classes (medical writing, obtaining extramural support), postdoctoral career advising and courses in the ethical conduct of research. A successful strategy to attract individuals from under-represented minorities will be maintained. Internal and External Advisory Committees review trainee progress and programmatic direction. Over the past 15 years metrics of the training program's success include: 1) recruitment of outstanding MD, MD/PhD and PhD trainees, 2) > 95% of trainees completing the program (several having obtained advanced degrees), 3) an average of 6.2 manuscripts published per trainee (many in high-impact journals), 4) a vast majority of trainees obtaining academic positions or pursuing additional postdoctoral studies. Programmatic enhancements described in this application include the new track in Outcomes and Health Services Research and enhanced ties to the Leonard Davis Institute of Health Economics, Penn's CTSA, and the department of Bioengineering.